Thrombotic Microangiopathy During Pregnancy: Role of Soluble Fms-like Tyrosine Kinase-1–Placental Growth Factor Ratios

IF 9.4 1区医学 Q1 UROLOGY & NEPHROLOGY

American Journal of Kidney Diseases Pub Date : 2026-02-01 Epub Date: 2025-12-04 DOI:10.1053/j.ajkd.2025.09.017

Daan P.C. van Doorn , Salwan Al-Nasiry , Marc E.A. Spaanderman , Jan G.M.C. Damoiseaux , Pieter van Paassen , Sjoerd A.M.E.G. Timmermans

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Abstract

Thrombotic microangiopathies (TMAs) are severe endotheliopathies that can arise in pregnancy and require early recognition. Complement-mediated (C-)TMA should be differentiated from other endotheliopathies of pregnancy because the treatment differs. Here, we report a case of a pregnant woman with acute kidney injury requiring hemodialysis due to C-TMA on the background of a pathogenic C3 variant at 28+5 weeks of gestation. The low soluble Fms-like tyrosine kinase-1 to placental growth factor (sFlt1/PlGF) ratio excluded pre-eclampsia. Eculizumab was started, and therapeutic drug monitoring was applied for optimal dosing. Despite prolonged hemodialysis, fetal well-being was preserved, and delivery was safely postponed till 34+3 weeks of gestation, resulting in a healthy neonate. We also separately report on sFlt1/PlGF ratios measured in a cohort of 11 patients with TMA and coexisting pregnancy. Ten of 11 patients (91%) had low sFlt1/PlGF ratios, excluding pre-eclampsia. Thus, successful pregnancy in women with C-TMA can occur, and sFlt1/PlGF ratios may aid in clarifying the diagnosis and appropriate treatment.

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妊娠期血栓性微血管病变：可溶性fms样酪氨酸激酶-1-胎盘生长因子比值的作用

血栓性微血管病变（TMAs）是严重的内皮病变，可在怀孕期间出现，需要早期识别。补体介导的（C-）TMA应与其他妊娠内皮病变区分开来，因为治疗方法不同。在这里，我们报告了一例妊娠28+5周时因致病性C3变异的C-TMA导致急性肾损伤需要血液透析的孕妇。低可溶性fms样酪氨酸激酶-1与胎盘生长因子（sFlt1/PlGF）比值排除先兆子痫。开始使用Eculizumab，并应用治疗药物监测以获得最佳剂量。尽管长时间的血液透析，胎儿的健康得到了保护，分娩被安全推迟到妊娠34+3周，产生了一个健康的新生儿。我们还单独报道了11例TMA合并妊娠患者的sFlt1/PlGF比值。11例患者中有10例（91%）sFlt1/PlGF比例较低，不包括先兆子痫。因此，C-TMA患者可以成功怀孕，sFlt1/PlGF比值可能有助于明确诊断和适当的治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Kidney Diseases 医学-泌尿学与肾脏学

CiteScore

20.40

自引率

2.30%

发文量

732

审稿时长

3-8 weeks

期刊介绍： The American Journal of Kidney Diseases (AJKD), the National Kidney Foundation's official journal, is globally recognized for its leadership in clinical nephrology content. Monthly, AJKD publishes original investigations on kidney diseases, hypertension, dialysis therapies, and kidney transplantation. Rigorous peer-review, statistical scrutiny, and a structured format characterize the publication process. Each issue includes case reports unveiling new diseases and potential therapeutic strategies.